Complications of Decompressive Craniectomy

Margules, Andrew; Jallo, Jack

doi:10.29046/jhnj.005.1.004

Cited by 10 publications

(14 citation statements)

References 68 publications

(67 reference statements)

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“…The mean age was 50 years old (range 17-85). The mean preoperative GCS score was 8 (range [3][4][5][6][7][8][9][10][11][12][13][14][15]. 70 patients had intracerebral hemorrhage (36.6%), 60 had ruptured aneurysm (31.4%), 21 had brain edema secondary to a prior elective brain surgery (11%), 15 had stroke (7.8%), 11 had closed head trauma (5.7%), 4 had thrombosed aneurysm (2.1%), 3 had ruptured arteriovenous malformation (AVM) (1.6%), 2 had penetrating trauma (1.4%), 1 had tumor (0.5%), and 3 were unreported (1.6%).…”

Section: Resultsmentioning

confidence: 99%

“…[1][2][3][4][5][6]10 When standard treatments for elevated ICP are exhausted without any signs of improvement, decompressive craniectomy can be an effective alternative solution. 7,19 Decompressive craniectomies (DC) have been used as a method of controlling intracranial pressure in patients with cerebral edema secondary to cerebral ischemia, subarachnoid hemorrhage (SAH), and traumatic brain injury (TBI), among others. [8][9][10] Several studies over the years have demonstrated the efficacy of this procedure.…”

Section: Trauma Introductionmentioning

confidence: 99%

“…[8][9][10] Several studies over the years have demonstrated the efficacy of this procedure. [7][8][9]11,35,36 However, consensus is still lacking in the utility of DC as an effective first tier treatment for intractable intracranial pressure due to the rudimentary neurological outcome assessments, and the many complications associated with this procedure. 11,12,59 There are a limited number of studies that have looked at complications secondary to the procedure itself.…”

Section: Trauma Introductionmentioning

confidence: 99%

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Complications of Decompressive Craniectomy

Ho¹,

Ooi²,

Sheikh³

et al. 2012

JHN Journal

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Section: Resultsmentioning

confidence: 99%

Section: Trauma Introductionmentioning

confidence: 99%

Section: Trauma Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Complications of Decompressive Craniectomy

Ho¹,

Ooi²,

Sheikh³

et al. 2012

JHN Journal

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“…In our study, patients who developed hydrocephalus following cranial surgery performed for brain tumors had a significantly decreased median time to first shunt failure. This may be explained by the extensive manipulation and injury to tissues incurred during resection of neoplastic disease as well as the alterations in cerebral blood flow and auto-regulation that develops after the procedure (19,29,46,47).…”

Section: █ Discussionmentioning

confidence: 99%

Ventriculoperitoneal (vp) shunt survival in patients developing hydrocephalus after cranial surgery

Khan

Rehman²,

Shamim³

et al. 2014

Turkish Neurosurgery

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ABSTRACThydrocephalus following cranial surgery is a well-recognized phenomenon (29) and results from a combination of collateral damage incurred during the surgical procedure (19) and the alterations occurring later in the CSF circulation, cerebral blood flow (CBF) auto-regulation and cerebral compliance (47).Complications resulting from VP shunts are notoriously common (7,9,13,24) and have been a subject of extensive research. (26, 27, 51) However, only a few studies have focused on VP shunt survival in patients who develop hydrocephalus as a consequence of cranial surgery itself. In this study, we report our experience of managing post-cranial surgery hydrocephalus in both pediatric and adult patients with particular emphasis on shunt complications and factors influencing shunt survival. █ INTRODUCTIONHydrocephalus results from abnormal production, flow or absorption of cerebrospinal fluid (CSF) causing an "active distension" of ventricles of the brain (40). Left untreated, this condition can lead to rapid deterioration and adverse long-term outcomes, both in pediatric (45) and adult (28) patients. Prompt CSF diversion with ventriculoperitoneal (VP) shunt insertion remains the most popular treatment for hydrocephalus (17).A number of classification schemes have been proposed to categorize hydrocephalus (3,22,32,33,37). However, no single scheme is comprehensive enough to encompass all aspects of this diverse entity (40). The development of AIM: Ventriculoperitoneal (VP) shunt insertion remains the most popular method for the treatment of hydrocephalus despite its associated complications. We assessed VP shunt survival in a group of patients who had developed hydrocephalus following cranial surgery. MATERIAL and METHODS:A retrospective charts review was done over a 10-year period at our institution. Kaplan-Meier survival curves and Log-Rank (Cox-Mantel) test were used to analyze various factors affecting VP shunt survival. RESULTS:Among the 67 cases included, a total of 28 (46.3%) patients had undergone cranial surgery for brain tumors. The overall rate of shunt failure was 14.9% at a mean follow-up of 16 months. Shunt failure in pediatric patients (20%) was slightly higher than that in adult patients (13.5%). The median time to first shunt failure was adversely influenced by a history of brain tumor (p = 0.019), prolonged antibiotic therapy (p = 0.018) and administration of steroids (p = 0.004).CONCLUSION: Shunt survival was worse in patients who developed hydrocephalus following cranial surgery performed for brain tumors and those who received either steroids or prolonged antibiotic therapy. Thus post-cranial surgery hydrocephalus represents a unique subset of hydrocephalus.

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“…Among well recognized complications are progression of haemorrhagic contusion, external cerebral herniation, subdural hygroma, infection, hydrocephalus, syndrome of trephined and epilepsy. Margules et al, 2010) Yang et al reported 50% complication rate after decompressiove craniectomy with 25,9% of patients who developed more than one complication. (Yang et al, 2008) There seems to be an association between the severity of the initial injury measured by the Glasgow Comas Scale, and the outcome of decompressive craniectomy.…”

Section: Complicationsmentioning

confidence: 99%